[Federal Register Volume 86, Number 48 (Monday, March 15, 2021)]
[Notices]
[Pages 14329-14331]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-05322]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4195-FN]


Medicare Program; Approved Renewal of Deeming Authority of the 
National Committee for Quality Assurance for Medicare Advantage Health 
Maintenance Organizations and Preferred Provider Organizations

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final notice.

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SUMMARY: This final notice announces our decision to renew the Medicare 
Advantage ``deeming authority'' of the National Committee for Quality 
Assurance (NCQA) for health maintenance organizations and preferred 
provider organizations for a term of 6 years.

DATES: The decision announced in this final notice is effective 
December 30, 2020 through December 30, 2026.

FOR FURTHER INFORMATION CONTACT: Greg McDonald, (410) 786-8941.

SUPPLEMENTARY INFORMATION:

I. Background

    Under the Medicare program, eligible beneficiaries may receive 
covered services through a Medicare Advantage (MA) organization that 
contracts with CMS. The regulations specifying the Medicare 
requirements that must be met for a Medicare Advantage Organization 
(MAO) to enter into a contract with CMS are located at 42 CFR part 
422.These regulations implement Part C of Title XVIII of the Social 
Security Act (the Act), which specifies the services that an MAO must 
provide and the requirements that the organization must meet to be an 
MA contractor. Other relevant sections of the Act are Parts A and B of 
Title XVIII and Part A of Title XI pertaining to the provision of 
services by Medicare certified providers and suppliers. Generally, for 
an entity to be an MA organization, the organization must be licensed 
by the state as a risk bearing organization, as set forth in 42 CFR 
part 422.
    As a method of assuring compliance with certain Medicare 
requirements, an MA organization may choose to become accredited by a 
CMS-approved accrediting organization (AO). By virtue of its 
accreditation by a CMS-approved AO, the MA organization may be 
``deemed'' compliant in one or more requirements set forth in section 
1852(e)(4)(B) of the Act. For CMS to recognize an AO's accreditation 
program as establishing an MA plan's compliance with our requirements, 
the AO must prove to CMS that its standards are at least as stringent 
as Medicare requirements for MA organizations. MA organizations that 
are licensed as health maintenance organizations (HMOs) or preferred 
provider organizations (PPOs) and are accredited by an approved 
accrediting organization may receive, at their request, deemed status 
for CMS requirements with respect to the deemable areas. At this time, 
recognition of accreditation does not include the Part D areas of 
review set out at 42 CFR 423.165(b). AOs that apply for MA deeming 
authority are generally recognized by the health care industry as 
entities that accredit HMOs and PPOs. As we specify at Sec.  
422.157(b)(2)(ii), the term for which an AO may be approved by CMS may 
not exceed 6 years. For continuing approval, the AO must apply to CMS 
to renew their deeming authority for a subsequent approval period.
    The National Committee for Quality Assurance (NCQA) was last 
approved as a CMS-approved accreditation organization for MA deeming of 
HMOs and PPOs for a 6-year term beginning on October 19, 2014, and that 
term lapsed on October 18, 2020, prior to our decision on its renewal 
application. NCQA did not accredit or re-accredit any HMOs or PPOs for 
MA deeming between that date and December 30, 2020, the effective date 
of its re-approval. On May 22, 2020, NCQA submitted an application to 
renew its deeming authority. On that same date, NCQA submitted 
materials requested by CMS that included information intended to 
address the requirements set out at Sec.  422.158(a) and (b) that are 
prerequisites for receiving approval of its accreditation program from 
CMS. CMS subsequently requested that additional materials and revisions 
be submitted by NCQA to satisfy these requirements. NCQA submitted all 
the necessary materials to enable us to make a determination concerning 
its request for approval as an accreditation organization, and the 
renewal application was determined to be complete on August 28, 2020.

II. Provisions of the Proposed Notice

    In the November 9, 2020 Federal Register (85 FR 71346), we 
published a proposed notice announcing NCQA's request to renew its 
Medicare Advantage deeming authority for HMOs and PPOs. In the November 
9, 2020 proposed notice, we detailed our evaluation criteria. Under 
section

[[Page 14330]]

1852(e)(4) of the Act and Sec.  422.158 (Federal review of accrediting 
organizations), we conducted a review of NCQA's application in 
accordance with the criteria specified by our regulations which 
include, but are not limited to the following:
     The types of MA plans that it would review as part of its 
accreditation process.
     A detailed comparison of the AO's accreditation 
requirements and standards with the Medicare requirements (for example, 
a crosswalk) in the following 5 areas: Quality Improvement, Anti-
Discrimination, Confidentiality and Accuracy of Enrollee Records, 
Information on Advance Directives, and Provider Participation Rules.
     Detailed information about the organization's survey 
process, including--
    ++ Frequency of surveys and whether surveys are announced or 
unannounced.
    ++ Copies of survey forms, and guidelines and instructions to 
surveyors.
    ++ Descriptions of--
    -- The survey review process and the accreditation status decision 
making process;
    -- The procedures used to notify accredited MA organizations of 
deficiencies and to monitor the correction of those deficiencies; and
    -- The procedures used to enforce compliance with accreditation 
requirements.
     Detailed information about the individuals who perform 
surveys for the accreditation organization, including--
    ++ The size and composition of accreditation survey teams for each 
type of plan reviewed as part of the accreditation process;
    ++ The education and experience requirements surveyors must meet;
    ++ The content and frequency of the in-service training provided to 
survey personnel;
    ++ The evaluation systems used to monitor the performance of 
individual surveyors and survey teams; and
    ++ The organization's policies and practice with respect to the 
participation, in surveys or in the accreditation decision process, by 
an individual who is professionally or financially affiliated with the 
entity being surveyed.
     A description of the organization's data management and 
analysis system with respect to its surveys and accreditation 
decisions, including the kinds of reports, tables, and other displays 
generated by that system.
     A description of the organization's procedures for 
responding to and investigating complaints against accredited 
organizations, including policies and procedures regarding coordination 
of these activities with appropriate licensing bodies and ombudsmen 
programs.
     A description of the organization's policies and 
procedures with respect to the withholding or removal of accreditation 
for failure to meet the accreditation organization's standards or 
requirements, and other actions the organization takes in response to 
noncompliance with its standards and requirements.
     A description of all types (for example, full, partial) 
and categories (for example, provisional, conditional, temporary) of 
accreditation offered by the organization, the duration of each type 
and category of accreditation and a statement identifying the types and 
categories that would serve as a basis for accreditation if CMS 
approves the accreditation organization.
     A list of all currently accredited MA organizations and 
the type, category, and expiration date of the accreditation held by 
each of them.
     A list of all full and partial accreditation surveys 
scheduled to be performed by the accreditation organization.
     The name and address of each person with an ownership or 
control interest in the accreditation organization.
     CMS also considers NCQA's past performance in the deeming 
program and results of recent deeming validation reviews or look-behind 
audits conducted as part of continuing federal oversight of the deeming 
program under Sec.  422.157(d).
    In accordance with section 1865(a)(3)(A) of the Act, the November 
9, 2020 proposed notice (85 FR 71346) also solicited public comments 
regarding whether NCQA's requirements met or exceeded the Medicare 
conditions of participation as an accrediting organization for MA HMOs 
and PPOs.

III. Analysis of and Responses to Public Comments on the Proposed 
Notice

    We received one public comment which is outside the scope of the MA 
deeming application renewal process.

IV. Provisions of the Final Notice

A. Differences Between NCQA's Standards and Requirements for 
Accreditation and Medicare's Conditions and Survey Requirements

    We compared the standards and survey process contained in NCQA's 
application with the Medicare conditions for accreditation. Our review 
and evaluation of NCQA's application for continued CMS approval were 
conducted as described in section II. of this final notice, and yielded 
the following:
     Pursuant to Sec.  422.158(a)(2), NCQA amended its 
crosswalk and standards to ensure current NCQA standards are clearly 
cross-walked to our regulations in each of five deemable areas: Quality 
Improvement, Anti-discrimination, Confidentiality and Accuracy of 
Enrollee Records, Information on Advance Directives, and Provider 
Participation Rules.
     NCQA submitted additional information and/or documentation 
regarding its survey process that was intended to address our 
regulations at Sec. Sec.  422.158(a)(1), (a)(3)(i), (a)(3)(ii), 
(a)(3)(iii)(A) through (C), (a)(4)(iii), (a)(6) through (11), and 
(b)(1) and (2).

B. Term of Approval

    Based on the review and observations described in section II. of 
this final notice, we have determined that NCQA's accreditation program 
requirements meet or exceed our requirements. Therefore, we approved 
NCQA as a national accreditation organization with deeming authority 
for MA HMOs and PPOs on December 30, 2020 for a term of approval to 
continue through December 30, 2026. We informed NCQA of their renewal 
via a letter from CMS dated December 30, 2020.

V. Collection of Information Requirements

    This notice announces the new term of approval for NCQA. Since it 
does not impose information collection requirements, that is, 
reporting, recordkeeping or third party disclosure requirements, there 
is no need for review by the Office of Management and Budget under the 
authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et 
seq.).

VI. Regulatory Impact Statement

    In accordance with the provisions of Executive Order 12866, this 
regulation was not reviewed by the Office of Management and Budget.
    The Acting Administrator of the Centers for Medicare & Medicaid 
Services (CMS), Elizabeth Richter, having reviewed and approved this 
document, authorizes Lynette Wilson, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.


[[Page 14331]]


    Dated: March 10, 2021.
Lynette Wilson,
Federal Register Liaison, Department of Health and Human Services.
[FR Doc. 2021-05322 Filed 3-12-21; 8:45 am]
BILLING CODE 4120-01-P